NHS Workforce

Debate between Steve Brine and James Murray

Tuesday 6th December 2022 Commons Chamber

[James Murray (Ealing North) (Lab/Co-op)]

There can be no doubt that the NHS is in crisis. We have heard shocking stories today from hon. Members about what their constituents are having to endure. Each and every one of these deeply distressing stories helps to confirm the devastating impact of the Conservatives’ neglect of the NHS. Patients deserve so much better than this Government and everyone who works in the NHS deserves so much better, too, for the invaluable work they do.

We all know that from the experience we have in our constituencies, as we have heard so powerfully today. My hon. Friend the Member for West Ham (Ms Brown) spoke powerfully and in detail about the impact of vacancies in the NHS, particularly in maternity services, in her constituency and the surrounding areas. My hon. Friend the Member for Coventry North West (Taiwo Owatemi) spoke about the role of community pharmacists and the wider struggles that NHS workers face. She was speaking with particular authority, given her background in the NHS before becoming an MP. My hon. Friend the Member for Ilford South (Sam Tarry) spoke about the severe impact of vacancies and exhaustion in nursing after 12 years of the Conservatives.

My hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) spoke about the impact that workforce shortages were having, even before the pandemic, on crucial radiotherapy services in her constituency and beyond. My hon. Friend the Member for Streatham (Bell Ribeiro-Addy) spoke about the scale of the crisis that we face in NHS recruitment and retention. My hon. Friend the Member for Leeds East (Richard Burgon) rightly mentioned those shameful attacks by Conservative Ministers on nurses.

My hon. Friend the Member for Bristol South (Karin Smyth) spoke with great experience, having spent three decades working in the NHS, about the growing crisis of retention over the past decade. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) spoke about the NHS crisis and set it in the context of the Government’s unfair decision in the recent autumn statement. My hon. Friend the Member for Halifax (Holly Lynch) gave a wide-ranging and powerful speech that drew attention to the genuine sense of fear among people across the country at the prospect of not being able to access vital NHS services. My hon. Friend the Member for Wirral West (Margaret Greenwood) made it clear that the staffing crisis in the NHS is the failure of 12 years of the Conservatives.

Madam Deputy Speaker, that is the truth. The Conservatives have spent 12 years running down the NHS and letting our economy fall further and further behind, but, make no mistake, this is not inevitable. After 1997, Labour not only grew the economy 1.5 times the rate that the Conservatives subsequently managed, but delivered an NHS to be proud of, and we are proud of our record.

Although the challenges now are even greater than they were in the late ‘90s, if we take office at the next election, we will, again, deliver a modern, sustainable NHS that is fit for the future that we face. We know that, to make the NHS fit for the future, it needs a prescription of reform and sustainable funding from a growing economy. For our economy to grow, we need to start getting our public services back on track, too. As my hon. Friend the shadow Health Secretary set out, one of the first steps that a new Labour Government will take to get the NHS back on track is to deliver a workforce plan that addresses the root cause of the crisis it is in.

Under our plan, we would double the number of medical school places to 15,000 a year. We would double the number of district nurses qualifying each year. We would train 5,000 new health visitors a year and we would create 10,000 more nursing and midwifery clinical placements each year, too—all part of a long-term workforce plan for our NHS.

[Steve Brine]

On the doubling of the number of medical school places, can the hon. Gentleman tell me what the cost of that is, especially as the shadow Chancellor is so handily sitting next to him? It would be helpful for those of us on the Select Committee to put the price tag on that one.

[James Murray]

All the pledges that the Opposition make are fully costed and fully funded. [Interruption.] If the hon. Gentleman waits one second, I will address that point. Today is about political choices. It is not just a political choice of whether we invest in the NHS; it is a political choice of how we pay for it. That is why we have made it clear that, to pay for our NHS workforce expansion plan, Labour would abolish the unfair, outdated non-dom tax status. Non-dom tax status is passed down through people’s fathers and it costs the public purse £3.2 billion a year, while failing to support economic growth in the UK. Under the current arrangements, a small group of high-income people who live in the UK are able to avoid paying tax on their overseas income for up to 15 years. We would abolish that 200-year-old tax loophole and introduce a modern scheme for people who are genuinely living in the UK for short periods. We believe that if a person makes Britain their home, they should pay their taxes here.

Health and Social Care Levy (Repeal) Bill

Debate between Steve Brine and James Murray

Committee stage
Tuesday 11th October 2022 Commons Chamber

[James Murray]

We know that the Bill is straightforward in what it seeks to achieve: as clause 1 sets out, it simply repeals the Health and Social Care Levy Act 2021. Ministers are asking us today to overturn a piece of legislation that they and their colleagues strained to defend and voted in favour of a little over a year ago.

As I set out on Second Reading, we welcome Ministers scrapping the tax rise on working people introduced by last year’s Act, but while the levy was not due to come in until April 2023, and the Bill means that the levy will never be charged, the Act also raised national insurance contributions for the current financial year 2022-23 as a transitional measure. As clause 2 confirms, the Bill keeps national insurance contributions at that higher level for the first seven months of this year, before letting them return to their previous levels from November. The decision by Ministers to scrap the national insurance rise is, of course, better to have come late than never, but this in-year change means that yet another cost will be paid for through working people’s taxes, as public money pays to undo the mess created by the Tories having made the wrong call last year. The explanatory notes to the Bill confirm that there will be a cost of an in-year change. Under “Financial implications of the Bill”, they state:

“HMRC anticipates increased call volumes and customer contact as a result of the in-year reduction of NICs rates. There will be delivery costs in implementing this policy. IT changes will be required to be delivered at additional cost to HMRC, to support safe delivery of this policy.”

All this could have been avoided if Ministers had simply listened to people across the country, to the Opposition, to Members on their own side, to the Federation of Small Businesses, the British Chambers of Commerce, the CBI, the TUC and so many others. If Ministers had listened, they would have realised that it was wrong to go ahead with this tax rise on working people in the first place. While we know that the U-turn before us will cost more than if Ministers had made the right call last year, we do not have a figure from the explanatory notes for exactly how much this will cost. On that point, the Bill’s notes simply say that

“Costings will be set out in due course.”

In other times, I might have read that statement and concluded that Ministers genuinely do not know the costings, but if their behaviour over the OBR report is anything to go by, it could be that they are simply refusing to publish those costings for political reasons.

It is because of this Government’s lack of willingness to subject themselves to transparent scrutiny that we have tabled new clause 1. New clause 1 would require the Chancellor to publish a report on the financial implications of the Act on the day that it comes into force. That report must make an assessment of the Treasury’s plans to raise an amount of revenue equivalent to the proceeds of the levy in the context of its approach to general taxation and borrowing.

As I mentioned on Second Reading, the Economic Secretary to the Treasury confirmed in a letter sent to the shadow Chancellor and the shadow Secretary of State for Health and Social Care on 22 September that:

“The additional funding used to replace the expected revenue from the Levy will come from general taxation and may require further borrowing in the short-term.”

We already know that borrowing is set to soar thanks to the Government’s disastrous and discredited approach to the economy. We know that their approach has inflicted huge harm on our economy, damaged our international standing and pushed up mortgage payments for households across the country. We know in particular that the Government’s failure to publish the OBR report showing the detail behind their approach has aggravated the spooking effect on markets. Through our new clause, we would require the Government to explain how they will maintain the funding equivalent to the levy, given their wider reckless decisions on borrowing and the economy.

New clause 1 refers to general taxation. As Members may recall, when they announced the health and social care levy last year, the former Prime Minister and Chancellor explained that, alongside the national insurance increase, the Government would also increase taxes on income from dividends at the same time. On 7 September last year, the previous Prime Minister, the right hon. Member for Uxbridge and South Ruislip (Boris Johnson), said:

“because we are also increasing dividends tax rates, we will be asking better-off business owners and investors to make a fair contribution too.”—[Official Report, 7 September 2021; Vol. 700, c. 154.]

The question arises of why the current Prime Minister and Chancellor have decided to cut this tax rate from April 2023. They do not need to scrap the dividends tax rise as part of the repeal of the Health and Social Care Levy Act—the dividend rate does not appear in that Act—but they have none the less committed to doing so. I would be grateful if the Minister could set out whether he agrees with the former Prime Minister’s argument that having a higher tax rate on dividends means asking better-off people to make a fair contribution. If so, can he confirm why the Government have decided that it is the right time to cut taxes for those who are better off, even if that means greater borrowing funded by all taxpayers?

As I have made clear throughout, we are glad that the Government are using the Bill to finally scrap this tax rise on working people, but it is clear that taxpayers will pay yet again to fix the mess the Tories have created, that Ministers are planning to again cut taxes for those they have described as the better-off and that this Government are desperate to avoid scrutiny of their plans. It is with that final point in mind that we ask Conservative Members who are uncomfortable with their Government’s approach to join us in supporting new clause 1.

Our new clause would simply require the Treasury to be transparent about how it will replace the money for health and social care that will no longer accrue from the health and social care levy, in the context of its wider approach to taxation, borrowing and the economy. As we have heard throughout the day in Parliament, there is widespread concern that the Government’s plans do not add up and that their lack of transparency is making matters worse. Our new clause makes clear to Ministers that this must change.

[Steve Brine]

I was not planning on speaking, but there are a couple of points that I would like to put on record, as a former Health Minister. I will not revisit the debate on the leadership campaign in the summer, or support new clause 1. I listened carefully to the hon. Member for Ealing North (James Murray) setting out his argument, and I have some sympathy with some of it, as he probably gathered from some of my interventions earlier.

I was happy to support the Second Reading of this repeal Bill—not that we had a Division on it. The Bill was well trailed throughout the ridiculously long leadership campaign in the summer; I do not think that that was the issue that spooked the markets at the time of the fiscal event a couple of weeks ago.

As my hon. Friend the Member for South Suffolk (James Cartlidge) said so eloquently on Second Reading, this is probably the most important debate that we could be having; I am miffed that the House of Commons is so quiet. It is about funding the British public’s No. 1 priority: the national health service. It was about that when we passed legislation on the levy, and it is about it now that we are repealing it. The issues have not gone away. I will listen carefully when the case for new clause 2 is outlined, but new clause 1 looks down the wrong end of the telescope. My hon. Friend cited the Office for Budget Responsibility’s projection that NHS funding will, in coming years, go from about 10.3% to 17.5% of GDP. Those are eye-watering figures. I have to say, as a former Minister for public health, primary care and prevention, that we cannot simply carry on that curve.

I want to put on record my points on three or four of the big challenges that the health service faces. If the Government let ideology get in the way of facing down those challenges, future generations—and Governments, whether Conservative or Labour—will pay the price. Take obesity. UK-wide, the NHS costs attributed to being overweight and obesity are projected to reach £9.7 billion by 2050. When I was in the Department of Health, we wrote the child obesity strategy. It is fair to say that the former Prime Minister, my right hon. Friend the Member for Uxbridge and South Ruislip (Boris Johnson), did not like a lot of it when he was running for the leadership of our party. In fact, I think he referred to the sugar tax as a sin tax, but—let the sinner repent—he came round to it. Now I hear rumours that it is for the bin.

I hear rumours that many other measures, including those around price promotion—"buy one, get one free”, as it is colloquially known—are also potentially for the bin, because we do not want to be seen as a nanny state. This from the state that recently passed a law making it illegal to leave the house without good reason. Sometimes, the state does things in the interests of the population that it serves, and there is no shame in that. If we do not tackle the obesity challenge, it will have not only a big financial impact on the NHS, which we are talking about how to fund, but a big social impact.

That takes me to my second point, which is on cancer. Around four in 10 cancers today are preventable. Smoking causes at least 15 different types of cancer. It is the biggest cause of cancer in the world today. Earlier, the hon. Member for Stockton North (Alex Cunningham) mentioned the smoking cessation plan, which I published when I was in office, and subsequently updated. We are still waiting for its revision. Press reports say that it is to be dropped as well. I gently suggest that that would be a massive own goal for our Government, and for the NHS, which we argue about how to fund.